Thread: Back to school, great class, and self harm...

My understanding of self-mutilation/cutting is that it's done by the student to gain 'control' over themselves/environment. I suppose it would be related to the same forces that result in eating disorders.

I've search a bit and find little in the way of guidance for teachers of the students, mostly along the line of 'alleviating stress' and increasing 'self-esteem'.

I suppose a tactic I would try would involve allowing for choices in how the students address an assignment. As much as feasible I'd try offering the class their choices in forms of presentations of assignments, whether or not they prefer to work in groups or individually.

I've only had one student I was aware of that was 'cutting' but we knew from the psychiatrist that the issues had stemmed from home problems, not school. At school she felt 'safe,' she liked the consistency and rules, so certainly more 'choices' may not have been the way to go with her. I guess bottom line, you need to get to know the student and as much background as you're able to get.

Self Injurious Behavior seems to be a growing trend. I have 2 students now both with different ways of injuring. It is scary and few of us have a frame of reference for it. It is truly a way to manage their emotions which run the gambit from anger to anxiety.

I have one where the combination of attention and horror have increased the behavior (and his mother doesn't like it). We are working closely with mental health.

Offering options for assisgnments is a good idea but it is not the assignment that will push one over the edge. Being available, making it known that you are aware of the situation...encourage communication. How is it being handled presently?

And, don't be afraid to ask for help from your administration.

I've had one cutter. I just made sure that my guidance people and the parents knew (they did already) and I justed treated the student with kindness and respect (about like everyone else) and I called on her in class sometimes because 1) she was a good student who often knew the answer and 2) she had a bit of a shyness problem. I don't think I'd handle it differently...good luck with yours.

There is a disturbing and growing trend with this "emo" movement that to be fully into the fashion style that they need to cut. A lot of the "emo's" at my school tend to cut their wrists, shallow, with things so it looks like they cut, but without the emotion behind it.
I have self harmed for years, for me it is about release and relief from overwhelming feelings and emotions. I don't need to do it at school because of all the rules and proceedures set up. I KNOW that every morning I have to go to staff brief, then homeroom, then first period. It is set in stone and there is little lee-way for things to be unpredictable about the routine. THe unpredictability for me comes from the students themselves. The fact that they will do unpredictable things just becuase they are students and are meant to do that. I find that hard to deal with. BUt that is just me. At home it is another story. I get so anxious and overwhelmed with myself that the only way to stop it is to cut.
For the students in my class who cut, if it is obvious I will ask about it. I will ask them how they got the cut on their wrist some will make up an excuse adn those ones i show more compasison to. Others will try to get a rise out of me by saying "I cut myself miss". Regardless of what they say, I have a little talk with them about dealing with emotions in a safe way and refer them on to the counsellor.
Don't be scared of this child in your class or of the fact that she cuts. Be aware that she isn't doing it in class and upsetting the other children, but appreciate it as best as you can as a way that she has found to deal with overwhelming forces in her life, it may not be a good way of dealing with it, but it is a way of dealing with it. Also offer her as many opportunities as you can to express her emotions in a safe and harm free environment.
For many people cutting brings relief and also shame. Relief from the emotions but shame at the fact that you have cut and also the need to hide it to stop seeing people's horror reactions. I am really careful to hide where I cut, I am ashamed that I have to cut and feel bad each time I cut, but it is just a part of dealing with what I am dealing with right now and i have faith it will stop itself when the time is right. Until then, I am working really hard not to feel the shame associated with it and trying to be as open as I can about it. your child may not be in the same place as me, but I think that with all of us who do cut that talking about it is really an important place because we do cut because of lack of forum to talk out emotions and things
For many people cutting/SI offers the chance to self soothe afterwards, something they may not do otherwise. In harming yourself you are giving yourself permission to look after yourself afterwards. This child may not get many opportunities in her home life to look after herself in a positive way and this allows her that opportunity. I know it is a thing for me to be able to look after my wounds properly even though they are self inflicted.
I know this all sounds crazy and it makes it sound like I am insane or kooky or something but it really isn't anything to be really scared about. I would watch out for things that indicate a big cut like being gentle towards a particular area like her thigh or something, protecting it from other kids etc Just be wary that she IS looking after herself properly.
A book about cutting, from a cutters perspective, is called "Bloodletting" by Victoria Letham (I'll check on the last name) It offers an insight into the thinking that goes on before self harm happens and she shares her journey through recovery also. I haven't really read any other books that I have identified with. A lot of them are by people who have lots of book smarts but don't actually cut and there is nothing worse than being told "you must feel like this" and have it wrong.
Anyways. DOnt be afraid of it or her. Good luck teaching her

Love Dawn

Here are some websites that may be helpful:

[url]http://www.angelfire.com/or/kharreshome/page2.html#not[/url]
[url]http://www.lifesigns.org.uk[/url]

I just got made moderator of the Self Injury forum at [url="http://www.pandys.org"]www.pandys.org[/url] I am so excited because I can reach out to memebers of that amazing community and help them now

ANyways. Was reasearching and found this online book which might help make things clear if you are still concerned about this issue:

[url]http://selfharm.net/injury.html[/url]

I've had a very close friend who cut themself so I know a little bit about it. It becomes something of an addiction over time, my friend did it for quite awhile, and then stopped when she became a Christian. However, even after stopping she talked to me sometimes about having a desire to start again. It becomes something that you almost need to do.

I'm not sure what it's purpose is exactly. As far as I know, it is usually a way for depressed people to remember that they're still alive. Something about the rush of pain is almost like a high to cutters.

As for how to treat them? Avoid losing your temper on her at all costs, chances are she is very sensitive, especially to comments that might make her start thinking about meaning and purpose. I'd also suggest avoiding literature that is really nihilistic in nature (or if you must cover it, explain the flaw in the nihilistic thought). And of course, just treat her like everyone else and treat her kindly.

Originally Posted by Xyphir

I just got made moderator of the Self Injury forum at [url="http://www.pandys.org"]www.pandys.org[/url] I am so excited because I can reach out to members of that amazing community and help them now

That must be a good feeling to know that you can use your experience to help others and point them in a better direction! Thank you.

I know that this isn't the right forum for this work, but seeing as your student is "old enough" (for some reason I thought she was a junior but after I re-read your post I can see that she is senior) and if you have a good enough rapport with her this is something that is very useful.
On Pandys, I am currently doing the affirmatoin challenge. We're up to day five and let me tell you - it FEELS like I am doing lines when I write up my affirmations twenty times, but I am detemrined not to cheat. heehe

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SI is such a taboo topic that it is difficult to find exercises that deal directly with it. Instead we often have to adapt different exercises from other "more acceptable" coping mechanisms such as eating disorders etc. The following exercises and words come From "The PTSD Workbook" by Mary Beth Williams and Soili Poijula. This workbook is an amazing collection of exercises to deal with the multitude of stuff that PTSD launches on us. I have found them very useful. I pick and choose the ones I do, but have put here all the ones from the book that relate to SI.

Pg 132 - 138

Self mutilation is a special type of self harm. It is direct, controlled, and repetitive, it does not have the intent o fsuicuide, it is not related to being impaired mentally or cognitively (eg being retarded or autistic) and it is socially unacceptable (Suyemoto and Kountz 2000) Self mutilation generally happens when you feel a deep loss that leads to feelings of tenseness anxiety, anger, or fear, and you express those feelings by harming your body in a very controlled manner. The most common form of self mutilation is self cutting. Cutting (and self mutilation in general) is:

• A way to manage painfrul emotions that you can't express in words by doing something that is concrete and active[/*:m:2z9um6d0]
• A way to stop feeling feelings and therefore control them[/*:m:2z9um6d0]
• A way to prove you are alive[/*:m:2z9um6d0]
• A way to reenact trauma and abuse[/*:m:2z9um6d0]
• An addictive action that can become compulsive[/*:m:2z9um6d0]
• A boundary violation of your body[/*:m:2z9um6d0]
• An expression of self-blame[/*:m:2z9um6d0]
• A way to self-soothe[/*:m:2z9um6d0]
• A way to communicate an emotion[/*:m:2z9um6d0]
• An expressoin of self hate[/*:m:2z9um6d0]
• A way to resist taking care of yourself in a positive way[/*:m:2z9um6d0]
• A way to maintain a stable sense of self if you are threarened with the loss of your identity[/*:m:2z9um6d0]
• A way to have physical evidence of emotional injury[/*:m:2z9um6d0]
• A way to distance yourself and set boundaries between yourself and others who will reject you for self mutilating[/*:m:2z9um6d0]
• A way to stop, induce or prevent dissociation [/*:m:2z9um6d0]
• A way to release endorphins so you do not feel pain[/*:m:2z9um6d0]
• A way to self punish for doing certain behaviours or having certain thoughts or feelings that were punished in childhood by others[/*:m:2z9um6d0]

(Suyemoto and Kountz 2000; Alderman 1997)

As Alderman writes, " most self inflicted violence is the result of high levels of emotional distrerss with few available means to cope (2000.7). You may use or exprience self mutilation as a way to get control over your body, challenging those around you to care enough to notice and do something. FDo you see hurting yourself as a way to express your rage toward powerful others through hurting yourself? Self mutilation of any kind can be substitute for anger toward another as well as a desire (unconscious or conscious) to inflice pain on that person. Sometimes, the desire to hurt yourself is a way to fight depression and anxiery or a way to numb yourself out thorugh a type of self medication. Sometimes self mutilation is a way to show how much you hate yourself. Eating disorders involving starvation and purging yourself to the point of physical pain can also be a form of self mutilation. You may also self mutilate as a way to reconnect your body and mind. Some people say that they are able to believe and recognise that they are real and alive if they see blood. Self multilationg, to them, may calm their intrusive trauma based thorughts by giving them the endorphin release that brings calming and lessens their arousal.
If you self mutilate, complete the following exercise. Above all, it is important for you to go to a qualified therapist to get help. No self abuse is ok; it is a way of revictimising youself. There are other ways for you to communicate your pain and anguish without taking it out on your own body. When you have very strong emotions of any kind, you do not have to act on them. Setting up a plan of alternative reactions to strong feelings is one way to bring self mutilation under control

Exercise: My reasons for self mutilating

1. List the ways you self injure here: __________________________________________________ _____________________
2. Now answer the following questions about each of these behaviours:

• How does the behaviour help me survive?__________________________________________[/*:m:2z9um6d0]
• How does the behaviour give meaning to my trauma?__________________________________[/*:m:2z9um6d0]
• How does the behaviour give me a sense of mastery and control and power?_______________[/*:m:2z9um6d0]
• How does the behaviour release endorphins and make me feel better?____________________[/*:m:2z9um6d0]
• How does the behaviour give me revenge?_________________________________________[/*:m:2z9um6d0]
• How does the behaviour reinforce my feelings of guilt, shame and selfblame?__________________[/*:m:2z9um6d0]
• How does the behaviour punish me?_____________________________________________[/*:m:2z9um6d0]
• How does the behaviour reenact what I learned earlier in life?____________________________[/*:m:2z9um6d0]
• How does the behaviour bring me affectoin, care and emotional closeness?____________________[/*:m:2z9um6d0]

3. Check all the items that you feel apply to you in the list below:
I mutilate myself because

• I want to show that I own my own body[/*:m:2z9um6d0]
• I want to express rage at myself[/*:m:2z9um6d0]
• I hat emyself[/*:m:2z9um6d0]
• I want to distrace myself from other pain[/*:m:2z9um6d0]
• I want to numb out my feelings[/*:m:2z9um6d0]
• I have a message to give that i can't say directly[/*:m:2z9um6d0]
• I am asking for help[/*:m:2z9um6d0]
• I want to be rescued[/*:m:2z9um6d0]
• I believe my body is a battleground[/*:m:2z9um6d0]
• I want to cleanse myself[/*:m:2z9um6d0]
• I want to somehow atone for my sins[/*:m:2z9um6d0]
• I want to express my shame[/*:m:2z9um6d0]
• I am trying to express my pain[/*:m:2z9um6d0]
• I am taking over where my abuser left off[/*:m:2z9um6d0]
• I am retaliating against myself for telling secrets[/*:m:2z9um6d0]
• I am doing what my abuser brainwashed me to do, if I told.[/*:m:2z9um6d0]
• I am trying to connect my mind with my body[/*:m:2z9um6d0]
• I am trying to make sure I am real, through bleeding[/*:m:2z9um6d0]
• I am trying to bring my emotions under control[/*:m:2z9um6d0]
• I am trying to prove that I am alive[/*:m:2z9um6d0]
• I am tryin gto get a "high"[/*:m:2z9um6d0]
• I am trying to manage my flashbacks or memories[/*:m:2z9um6d0]
• I am trying to release intolerable emotional tension[/*:m:2z9um6d0]
• I am trying to buy myself time by focusing attention on physical rather than emtional pain[/*:m:2z9um6d0]
• I need to get into a "neutral zone"[/*:m:2z9um6d0]

4. Now take each of the reasons for self injuring that you chekced and think of five other things you might do to express that emotion or actoin. For example, if you checked "I want to cleanse myself" as a reason for self mutilatin, what are five other things you could do to cleanse yourself that do not involve self mutilation? They migth be to take a bubble batgh, take a sauna, go to a day spa, use herbs to purify my body, or do som other form of cleansing ritual. You may think of other that might apply to you.
My reason for self mutilating:_______________________________________ __________________________
Five things I could do instead:
1. __________________________________________________ __________________________
2. __________________________________________________ __________________________
3. __________________________________________________ __________________________
4. __________________________________________________ __________________________
5. __________________________________________________ __________________________

5. What did completing this exercise teach you about yourself? ____________________________________

Beliefs leading to self mutilation

You may also have a belief system that allows you to mutilate yourself. These beliefs frequently are distorted and may even have come from your abusers (as introjects you have taken into your own brain and now experience as your own beliefs) These beliefs are geenrally black and white or all or nothing beliefs.

Exercise: My beliefs about self mutilation

Check which of the following statements you believe, if any:

• Self mutilation doesn't hurt anyone but me and it really doesn't hurt me[/*:m:2z9um6d0]
• Its my body, I can do what I want with it[/*:m:2z9um6d0]
• It's no big deal and shouldn't upset anyone[/*:m:2z9um6d0]
• If I dont hurt myself this way, my pain will be worse[/*:m:2z9um6d0]
• The scars are there for a reason; they remind me of (telling, needing to be punished, my shame etc)[/*:m:2z9um6d0]
• No one knows about it anyhow[/*:m:2z9um6d0]
• I need to be punished for what I did[/*:m:2z9um6d0]
• It just shows how bad a person I am[/*:m:2z9um6d0]
• It keeps people away[/*:m:2z9um6d0]

None of the statements in the preceding list is accurate or true. Each is a distorted belief. Self mutilation is never a healthy way to express pain or hurt. If you checked any of these statements, its important that you work with a therapist to help change these beliefs. Other things you might do with that therapist include developing an impulse control log (write what, when you feel the urge to harm yourself and waht you did instead) and think of ways to express your feelings that are not harmful to you. In the impulse control log, you may want to identify any triggers that led you to self mutilate. Other techniques to control self mutilatoin include:

• Try to focus your attention on something other than the need to self mutilate. Eg focus your attention on doing a crossword or jigsaw puzzle or some other intellectually stimulating challenge. This minimises emotional pain[/*:m:2z9um6d0]
• Make a list of alternatives to self harm[/*:m:2z9um6d0]
• Write or draw th abuseive intent rather than act on it[/*:m:2z9um6d0]
• Subsitute physical activity to get the same adrenaline high, if that is the motivatoin[/*:m:2z9um6d0]
• Make a collage of acceptable methods of self expression[/*:m:2z9um6d0]
• List the introjects that lead to self harm[/*:m:2z9um6d0]
• Develop a safety contract with your therapist or some other significant person and agree not to self mutilate for a specified period of time; include rewards for following the contract and consequences if you break it[/*:m:2z9um6d0]
• Develop a collage of each emotoin that you find difficult to handle or express including ways to release that emotion without self harm[/*:m:2z9um6d0]
• During a period of time that you dont feel self destructive prepare a list of reasons why you dont want to self mutilate. Then, when you feel the urge to hurt yourself, go back and review this list and try to add another one or two reasons to it[/*:m:2z9um6d0]
• Prepare a list or photo gallery of positive accomplishments in your life. When you feel the urge to self mutilate, look at that list or album and then tell yourself "I've accomplished all this good in my life and don't deserve to suffer more; I'm a good person"[/*:m:2z9um6d0]
• Learn to identify the early warning signs that a feeling is becoming intolerable and then self soothe or do aomething else. This technique involves identifying patterns of self injury as a first step to changing those patterns. How often do you delf injure (daily? weekly? sometimes? rarely?) Then look at what you were doing, thinking, or feeling right before the self injury happened and right after it happened (Trautman and Connors 1994)[/*:m:2z9um6d0]
• Look at the backlash that happens after you harm yourself - from others and from yourself. Do you: feel crazy, hurt physically, feel shame, try to hide from others? Use memories of that backlash as reminders why you do not want to hurt yourself.[/*:m:2z9um6d0]
• Create a safe toolbox that includes a non-harm agreement, an impluse control log, a list of your self harm alternatives, writing materials and art materials so you can get out yoru feelings and thoughts in other ways and a life plan (Alderman 1997)[/*:m:2z9um6d0]
• If you must see blood on yourself, get a tube of fake blood and use it to visualise the effects of self mutilation without actually carrying out the act[/*:m:2z9um6d0]
• Use affirmations to change your beliefs about why its ok to harm yourself[/*:m:2z9um6d0]

Changing your beliefs through affirmations

As we discussed in chapter 6, regular use of affirmations can change your beliefs abotu yourself and your emotions and actions based on those beliefs. This kind of real change has six stages and it does not happen overnight. These stages are:

1. Precontemplation (My negative beliefs about myself are right; I don't need to change them)[/*:m:2z9um6d0]
2. Contemplation (Well, maybe I do need to make some changes)[/*:m:2z9um6d0]
3. Preparation (I guess I can begin to focus on what I need to do and what affirmations I migth write or say)[/*:m:2z9um6d0]
4. Action (I will do and am doing this. I am saying or writing the affirmations on a daily basis)[/*:m:2z9um6d0]
5. Maintenance (I am begining to believe the affirmatoins. I dont need to say them as often and I sort of believe them. I am beginning to see things in a different way and feel better about me)[/*:m:2z9um6d0]
6. Termination - The ideal end (Wow, I actually am okay and dont need to see myself so negativly. SOmetimes I forget that I am okay, but I recover quickly. The affirmations really are acceptable ways to describe myself - they even work when I am in crisis. I am able to do what is best for me)[/*:m:2z9um6d0]

Exercise: My affirmations around self mutilation

In the space below, write three affirmations that you want to say to yoursef or write to yourself that you eventually hope to believe. Remember to put them in present tense adn use the word "I"

1. __________________________________________________ ________________[/*:m:2z9um6d0]
2. __________________________________________________ ________________[/*:m:2z9um6d0]
3. __________________________________________________ ________________[/*:m:2z9um6d0]

Now write each affirmation five times to begin to get familiar with it
__________________________________________________ ________________
__________________________________________________ ________________
__________________________________________________ ________________
__________________________________________________ ________________
__________________________________________________ ________________
Are you willing to write or say each of these three affirmations twenty times a day for the next month? If so, fill in the blanks below:

I am willing to commit to saying or writing each of these three affirmations twenty times a day for the next thirty days. At the end o fthat time, I will return to this page and write how I feel about the exercise and my beliefs

__________________________ (sign)____________________________
Your signature

Thirty days from that date is _______________ (fill in date). In the lat thirty days, this exercuse has:
__________________________________________________ ________________
__________________________________________________ ________________
__________________________________________________ ________________
__________________________________________________ ________________

Pg. 163
Some self esteem affirmations you may choose to use:

• I have worth[/*:m:2z9um6d0]
• I like myself for myself without comparing myself to others[/*:m:2z9um6d0]
• I can do good work at my job[/*:m:2z9um6d0]
• I do my best[/*:m:2z9um6d0]
• I care about others[/*:m:2z9um6d0]
• I make a differnece in my own life[/*:m:2z9um6d0]
• I make a difference in the lives of others[/*:m:2z9um6d0]
• I am worthy of love from myself[/*:m:2z9um6d0]
• I am worthy of respect from myself[/*:m:2z9um6d0]
• I am worthy of love from others[/*:m:2z9um6d0]
• I am worthy of respect from others[/*:m:2z9um6d0]
• I respect my own and others' boundaires[/*:m:2z9um6d0]
• I am lovable and capable[/*:m:2z9um6d0]
• I love myself unconditinoally[/*:m:2z9um6d0]
• I am capable of changing and growing[/*:m:2z9um6d0]
• I am willing to accept love[/*:m:2z9um6d0]
• I am proud of my body[/*:m:2z9um6d0]
• I am no longer a helpless child[/*:m:2z9um6d0]

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From DBT group

Thinking of the pros and cons

This skill consists of writing two sets of lists. It allows you to think about the positive and negative aspects of tolerating a crisis without doing something harmful or impulsive versus the positive and negative aspects of handling the situation by engaging in harmful or destructive behaviour. By doing this you can focus not only on the short term advantages and disadvantages of this behaviour but also take a more long term view and think about some of the negative consequenses which accompany destructive behaviour.

Instructions:
Draw up a table divided into four sections
The upper section is for a list of the pros and cons of not tolerating the distress - that is, coping by hurting yourself, abusing alcohol or drugs or doing something else impulsive or destructive
The lower section is for another list of the pros and cons of tolerating the distress - that is coping by using the crisis survival skills.

When making these lists look at both the short term positive and negative consequences and more long term positive and negative consequences. Think about and list the positive consequences of tolerating the distress and engaging in more ffective behaviour. Imagine in your mind you good you wil feel if you achieve your goals, if you dont act impulsively.
Think of all the negative consequences of not tolerating your current distress and of acting impulsively to escape the moment.
In your list, focus on your long term goals, the light at the end of the tunnel. Remember times when you have felt better



Pros and Cons

Here is some space to copy down an example of analysing the pros and cons of engaging in behaviour which is not helpful in the long term.

The unhelpful behaviour I am analysing is:__________________________________________